Tyler Internal Medicine Associates wants to increase patients’ access top service. When a patient fails to keep an appointment, professional time goes unused and other TIMA patients fail to receive timely service.

If we have made an error in scheduling or you believe you deserve special consideration for a “No-Show/No-Call Fee”, please complete the following information (along with any supporting documentation you may have). Your request will be reviewed, and you will receive a decision via a phone call.

Patient Information

Name DOB Address Phone Email Address Time and Date of missed appointment Provider Reason for appeal